Report at change of shift says Mrs. Barnes, a 47 yo, admitted with acute asthma, had a restless night. She is still dyspneic at 28 breaths/ min. and still demonstrating inspiratory and expiratory wheezes, but not as severe as on admission. She is maintaining an oxygen saturation of 90% – 92% on O2 at 4 L/min via nasal cannula. She is receiving breathing treatments every six hours but needed a PRN treatment around 0300. She is receiving IV fluids of NS at 150 mL/hr and an aminophylline drip at 35 mL/hr. As you enter the room to do your shift assessment, Ms. Barnes tells you, “I don’t know what is going on with me. I have to got to the bathroom all the time and I just can’t make it there. I am so embarrassed-I just wet myself in the bed. I can’t catch my breath when I get up plus, I can’t get there fast enough with all this stuff attached to me.”
She ask you, “Why do I have to go to the bathroom so much? How do you respond?
What would you expect the characteristics and specific gravity of her urine to be? Consider her situation.
What “at risk” nursing diagnoses might need to be addressed for this patient care situation related to the problem of functional urinary incontinence?
A toileting schedule is created to ensure that Ms. Barnes has adequate opportunity to void, therefore preventing episodes of incontinence. Due to Ms. Barnes’s dyspnea, it is decided to have her use a bedpan rather than ambulating to the bathroom.
How can you make this modality comfortable for Ms. Barnes?
Consider both the physiological and psychosocial aspects of voiding. Despite the interventions for asthma, Ms. Barnes’s respiratory status deteriorates and she is unable to use the bedpan without compromising her oxygenation status. You receive and order to insert an indwelling catheter to beside drainage to monitor and manager her urinary output.
What type of catheter will you choose to use for this intervention? Why?
How will you prepare Ms. Barnes both physically and psychologically for this procedure?
Ms. Barnes states, “I have to sit straight up or I can’t catch my breath- please don’t lay me down flat.” How will this affect the catheterization procedure? In reviewing the steps of catheterization, discuss why organization is key to implementation of this procedure for this patient. You write a nursing order for catheter care q8h for Ms. Barnes.
What are the goals of catheter care? What aspects of the each goal can be delegated to the nursing assistant?
During the shift you offer to assist the assigned aide, to help Ms. Barnes to move up in the bed. The aide places Ms. Barnes flat in the bed and carefully lays the drainage bag next to her thigh so it does not get pulled on during the repositioning, as this will cause discomfort. She instructs the patient to pull her knees up to help push with her feet and on the count of 3, you and the aide, using the draw sheet, pull Ms. Barnes up in the bed. The patient is placed back in high Fowler’s position and you ensure that the call light is within reach. The patient is appreciative of this repositioning.
Which aspects of this task, if any, indicate that review of this basic patient care task needs to be done with the nursing assistant? Explain. Mrs. Barnes respiratory status improves and you receive an order to remove the catheter.
What equipment will you need to implement this order? With the understanding of the Centers for Disease Control and Prevention (CDC) guidelines on prevention of catheter-associated urinary tract infections, are sterile gloves indicated for the procedure? Give the rationale for your decision.
After 8 hours Ms. Barnes is still unable to void post-catheter removal. She does not complain of discomfort and there is no abdominal distention. What measures can you implement to facilitate voiding? During the evening medication rounds, Ms. Barnes says to you, “I sure hope I don’t get an infection like I did with that catheter after my second baby was born. I was so miserable when I got home from the hospital. I know that was a long time ago but I sure do remember how miserable I was and it seems I have been prone to them ever since.”
Discuss the teaching you need to implement with her in the prevention of and/or surveillance for urinary tract infection.